Medical Claims Denial & Appeals Specialist

About the role

The Specialist is primarily responsible for resolving all insurance claim denials for assigned departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Denial Specialists are independently accountable for the denial resolution for their assigned divisions.

Responsibilities

• Audit and resolve insurance claim denials through coding review, contract review, medical record review and carrier interaction.
• Generate effective written appeals to carriers using well-researched logic.
• Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues.
• Utilize a multitude of resources to ensure correct appeal processes are followed.
• Communicate identified denial patterns to management.
• Prioritize and process large volume of denials and maintain high quality of work.
• Serve as an escalation point for unresolved denial issues.
• Inform team members of payer policy changes.
• Assist in training new employees as assigned.
• Collaborate on special projects as needed.

Requirements

• 3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up.
• Bachelor’s degree in a related field is strongly preferred.
• ICD-10 and CPT coding assessment skills, CPC certification is preferred.
• Intermediate PC software experience required.

Qualifications

• Prioritize and process large volume of denials and maintain high quality of work.
• Serve as an escalation point for unresolved denial issues.
• Inform team members of payer policy changes.
• Collaborate on special projects as needed.

Skills

• Requires a solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic.

Benefits

CU Medicine provides generous leave, health plans and retirement contributions which take your total compensation beyond the number on your paycheck.

Pay

The listed pay range (or hiring rate) represents CU Medicine’s good faith and reasonable estimate of the range of possible compensation at the time of posting and is based on evaluation of competitive market data. A variety of factors, including but not limited to, internal equity, experience, and education will be considered when determining the final offer.

Schedule

Candidates must be able to perform the essential functions of the job, including the performance of the above responsibilities, with or without reasonable accommodation.